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pwald614

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I am having trouble coding a FESS procedure with these new sinus codes. I just can't wrap my head around it sometimes. My physician did a Bilateral Balloon Sinuplasty (with removal of bone/tissue) along with a Right Total Ethmoidectomy, and Right Sphenoidotomy. Would I do 31253-RT, 31276-59LT, 31287-59RT? Because the Total Ethmoid and Sphenoid are both Right sided I am stumped! We are also hospital owned so those coders don't agree with me that you shouldn't code 31253 and 31257 at the same time unless they are opposite sides. Sigh.....Anyone help me out?
 
Only one of the new combo codes should be reported per side. I am going to assume, that Bilateral Balloon Sinuplasty means the Frontal Sinuplasty since you used the 31253 and 31276 codes. The 31253 includes the frontal and total ethmoidectomies. So in your case, 31253-RT would be the appropriate code to use for the RT side. On the left, only the frontal was done so that would be the 31276-LT. The sphenoid would be coded alone since the ethmoidectomy was coded with the frontal sinus. To code the sphenoid would be 31287-RT or 31288-RT depending if tissue was removed.


Brian Smith, CPC
 
Assuming the balloon sinuplasty with removal of bone and tissue was performed on Frontal (you do not indicate in your question)

You will optimize your RVUs if you report this as:

31276-50 for the bilateral frontal
31257-RT for the ethmoid and sphenoid

Barbara J. Cobuzzi MBA, CPC, COC, CPC-P CPC-I CPCO, CENTC
Consulting Editor Otolaryngology Coding Alert
www.CRNHealthcare.com
b.cobuzzi@att.net
 
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I do the coding for an ASC, my encoder program allows me to bill the 31255 bilateral with the 31276 bilateral if I use the "59" modifier. Medicare has been paying these, should I worry that they are going to come take all of these back?
 
tdesher, You should definitely worry about the coding that you are using. You are telling Medicare that you performed 31255-50 during one encounter and then going back and doing a second encounter where you do 31276-50, or that there is some unusual circumstances that support unbundling these two codes. But there are no circumstances that support unbundling. You must bill 31253-50 if a bilateral ethmoidectomy and bilateral frontal sinusotomy is performed. No other coding configuration is acceptable.
 
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